Provider Demographics
NPI:1518024512
Name:PETRUS, HEATHER M (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:M
Last Name:PETRUS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-9419
Mailing Address - Country:US
Mailing Address - Phone:315-224-0123
Mailing Address - Fax:
Practice Address - Street 1:2435 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-9419
Practice Address - Country:US
Practice Address - Phone:315-224-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health